SETTING UP TONYMED MEDICAL CENTRE TO REACH THE UN-REACHED

When Paul Tonui completed his training in Nursing, he landed a job at Tenwek mission Hospital in Bomet County.  Little did he know that the experience he got while working at the casualty and outpatient departments at the hospital would open his eyes to private practice and subsequently to the opening of Tonymed Medical Centre in Kiptagich, in South Rift Valley. It was during his tenure at Tenwek hospital that he realized that a good chunk of the patients he treated were coming from Kuresoi South and especially around Kiptagich town which was a long distance away. This gave Paul the idea to start his own clinic in the area and thus was born Tonymed Medical Centre. The clinic is found in a tea zone of Kuresoi South sub-county which is at the border of Nakuru county and within the Mau Forest zone.

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After gaining as much experience as he could while at Tenwek, in 2010, Paul made the big shift from hospital he had been employed in for 10 years to Kiptagich town where he set up his own clinic. Equipped with the necessary licenses, a stethoscope, thermometer, BP machine, a couch and a few tins of medicine, the clinic started operating in a small rented room which previously operated as a shop. His initial clients were those he had interacted with at Tenwek and whom trusted his capabilities. It was in the same year that Paul heard about Tunza and after learning about the benefits of the franchise decided to join. “I have so far been able to benefit from the various trainings, business advice and quality assurance education that hare offered by Tunza,” he narrated. “I have also benefited from a lot from trainings on Cervical Cancer screening and treatment, safe motherhood and demand creation from Tunza staff and I take this opportunity to thank them for equipping me with all these skills and due to them I see TonyMed Tunza Clinic growing into a big entity,” added  Paul.

Paul acknowledged that Tunza day events have marketed his clinic which has led to an increase in the number of clients that seek his clinic’s services; in turn, this has led to increased income as the many patients attending the clinic translate to more income for the clinic. In 2012, Paul managed to purchase a plot and build his own premise and has managed to move to the new premise which is spacious enough to attend to his clients.

In 2014 Tonymed Medical Clinic was allowed by Ministry of Health (MOH) to offer antenatal, immunizations and maternity services as well as offer screening and treatment services for TB. The work relationship between Paul and MOH is very good as he is usually invited to attend trainings and meetings by MOH and also get supplies and commodities support. He actually leads in most health indicators in the sub county and MOH is very happy with the services offered in his facility.

To ensure that he is able to take care of all his patients both cash paying and those with insurance cover, Paul applied and got accreditation for outpatient from NHIF in 2015. Currently he is attending to clients in the civil service, elderly, linda mama and national health schemes. He is currently doing some renovations to accommodate the inpatient section so that he can apply for the inpatient scheme from NHIF.

“I never imagined I could be where I am today and can only say that I am able to achieve what I have through God’s favor and the assistance I have gotten from the Tunza Network. Currently, I have employed 14 staff members who assist me attend to the 50 or so clients who visit us daily. Without them I would not be able to do my other side hustles and as we speak, I look forward to expanding my hospital with extra wards, X-rays, ultra sound and theatre machines” explained Paul.

PS Kenya is playing a major role through Tunza in ensuring health providers like Paul are able to offer quality services at the same time reap profits from their business.

 

 

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Security Guard Turned Community Health Worker

The month of March marked Health Workers Week, a time set out to celebrate these frontline health warriors. At PS Kenya our Community health volunteers  are our boots on the ground, reaching Sara with invaluable health information and services so that she lives a healthy happy life.  One of them is Mr Pote.

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A health facility just like any other business requires marketing to create awareness so that it can expand its client base. With services such as family planning (FP) and cervical cancer screening and treatment (CCST), the barriers to uptake of FP methods and services are deep and personal hence requires a more personal approach to convert awareness into uptake of services. To address this gap, PS Kenya has employed Interpersonal Communication (IPC) strategy to reach out to women of reproductive age (WRA) in the community through Community Health Volunteers (Tunza Mobilizers). The Tunza mobilizers are trained and equipped with IPC tools and attached to selected Tunza facilities to drive demand for the services.

As part of PS Kenya’s intensification strategy, Nuru Medical Clinic in Mtwapa, Kilifi County was selected as one of the facilities referred to as an “Intensification Site” for FP and cervical cancer screening and treatment services and therefore a Tunza Mobilizer was attached to it to help reach out to more women around Mtwapa. Our TMs are generally women but the one in Nuru is a gentleman – Mkanyi Pote. Pote as he is commonly referred by his clients, is a hardworking and very passionate community health worker, working in Mtomondoni village and Shimo la Tewa sub location in Mtwapa.

Pote had a different vision for his life but poverty led him down this road and although it was difficult at first, he is excited about his job and how he helps women in his community make healthy decisions. “I got to study until high school but unfortunately, my parents were not able to support my education any further and I could therefore not proceed to college. This did not deter me and I sought to find another way of building a career for myself,” says Pote. He embarked on job searching and finally secured a job at India Beach Hotel where he worked as a security guard for 2 years. In 1997, Mkanyi resigned and decided to follow his passion-community work. His community work begun when he signed up as a volunteer at the Mtwapa Health Center where KEMRI had a project on Malaria. He later found the Tunza Health Network where he has been working as a Tunza Mobilizer.

As a Tunza Mobilizer he has been trained to conduct health talks to women in his community around various health areas including safe motherhood, family planning, malaria prevention and treatment (using mRDT kit), safe water, HIV prevention and enlisting with NHIF. He was also trained as a Trauma Counsellor with Amani Counselling Center and Institute. Pote carries out his health talks at the household level through one-on-one visits and small group sessions. During this time, various organizations with projects around Mtwapa have also involved him especially on mobilization and community education. However, he confesses that being a man who talks to women about their reproductive health has been a challenge. On the one end, he has to cover long distances when doing his door-to-door visits because he is passionate about ensuring his clients follow through on their check-ups especially after receiving treatment. Other clients have high expectations of receiving some additional assistance especially when they see the him with his branded shirt and job-aids. In addition, Pote has on several occasions had to deal with suspicions from jealous husbands when he engages their wives during the household visits. “In most coastal culture, there is what we call the ‘Mwenye Syndrome’ where the man has the final say in all matters including those that are health related and most men are suspicious about another man talking to their wives about their health,” he said.

All these challenges he has been able to slowly overcome by persistence and growing the trust of their community.  Today, he boasts that his community is well informed about modern family planning methods and even embracing long-term family planning.  “Beforehand, there were very few women taking up family planning methods due to myths and misconceptions but through the constant talks and support from Tunza providers and the PS Kenya team, a lot of these myths have now been put to rest,” mentioned Pote.

But Pote is not the only community health worker targeting the women with health messages and getting audience with the women is a continuous challenge. However, over time, he has perfected his interpersonal communication skills which give him the edge and the trust of the community to do his work. All in all, Pote remains determined to soldier on empowering women and the community in general on matters health as he sees that as a way of giving back to his society.

IMPROVING IMMUNIZATION COVERAGE

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According to the national policy and guidelines on immunization, Kenya intends to attain 90% and 80% fully immunized child coverage nationally and in every county to ensure that children do not die due to diseases that can be prevented through immunization. A child is considered fully vaccinated when they have completed the immunization schedule and received the 2nd measles vaccine.

While the Government of Kenya provides routine and emergency vaccines free of charge in all public health facilities through the Unit of Vaccines and Immunization Services (UVIS), these services are not being fully utilized by caregivers. PS Kenya, through funding from USAID, is charged with the responsibility of creating awareness on the importance of immunization and therefore increase awareness of the vaccines offered to the target audience.

The Immunization Communication Objectives

 

The objectives of the immunization SBCC campaign is therefore to increase the number of caregivers who:

  1. Know the recommended number of vaccines for children under the age of 2 years.
  2. Know when to go to Health Facilities to complete the immunization schedule.
  3. Can recall at least 4 immunizations and the diseases they prevent.

This immunization social behaviour change communication campaign is therefore focused on one of the Counties with the lowest coverage in Kenya – Homabay County.

Understanding the Problem

In 2017, we carried out a household survey in Homabay County to ascertain the knowledge, attitude and practices that affect uptake of immunization. The baseline survey revealed that awareness of vaccines in general was highest at birth, similar to national trends observed in the 2014 KDHS. More than half of the respondents were aware of the immunization administered at 6 weeks after birth. Rural respondents recorded higher awareness numbers at 62% compared to the peri-urban respondents at 58%. The immunization awareness numbers were lowest in the subsequent months of 2 and a half to 3 and a half months for Pentavalent, Polio, Rotavirus and Pneumonia vaccines then a slight increase was observed for measles at 9 months. The baseline survey also indicated higher knowledge levels among rural based caregivers than among urban caregivers across various vaccines,

Radio was the primary source of information among caregivers (31%) and Community Healthy Volunteers was the second most important source of information (26%). Lack of knowledge was cited as a key barrier followed by caregiver attitudes and beliefs.

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Our Response

Based on the responses we got from the survey above, the immunization SBCC campaign was then implemented in Suba and Kabondo Sub Counties through:

  1. Trained Community Health Volunteers (CHVs) going door to door in mapped households to carry out interpersonal communication with caregivers of children under two years.
  2. Radio through the immunization campaign whose tagline is “Kutomaliza Chanjo ni kukatiza ndoto” based on the premise that immunization is the best option to safeguard the health and therefore dreams of one’s children.
  3. Targeted SMS was also used to speak to caregivers of children under 2 and expectant mothers.

Collaboration in the Immunization Project

The immunization project relies heavily on close collaboration of Homabay County Health Management Team (CHMT) led by the County Director for Health, Dr. Gordon Okomo and the County Extended Program on Immunization (EPI) Coordinator, Mrs. Christine Ong’ete, PS Kenya and partners supporting other aspects of the immunization project in the County. USAID supported quarterly consultative forums through which project progress was deliberated upon and further collaboration birthed.

ADOLESCENT GIRLS NUTRITION

THE WEEKLY IRON AND FOLIC ACID NUTRITION PROGRAM

Three counties in Kenya have anaemia rates which are higher than the WHO recommended rates of 20% and PS Kenya is intervening in those counties through a demonstration project to improve adolescent health and nutrition. Through the Weekly Iron Folic Acid Supplementation Project (WIFS), we target school going and out of school adolescent girls aged 10-19 years to ensure that they have enough iron to reduce anaemia by providing them with 60mg of Elemental Iron once a week. This will help with productivity, school performance and in the long run reduce child mortality and malnutrition rates.

WIFS ANZA CAMPAIGN POSTER

The 3 counties Busia, Kitui and Nakuru were selected based on the Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) framework that lists them among the 21 priority counties with poor reproductive health indicators. These counties are also listed under UNFPA as counties with high prevalence of maternal mortality and high cases of teenage pregnancies. The WIFS project is funded by Global Affairs Canada (GAC) Right Start initiative through Nutrition International (NI) formerly known as Micronutrient Initiative (MI). Because this is a unique audience, we use a 360⁰ ‘surround & engage’ communication strategy combining both existing and new communication messages and channels to influence behavior change towards the use and consumption of WIFS.

STORIES OF CHANGE: FROM ZERO TO HERO

In the middle of Busia county lies St. Mary’s Asinge Primary School in Teso South Sub County. The shool like others in the sub-county was mapped for the implementation of the WIFS demonstration project that seeks to improve the nutrition status of adolescents through nutrition education for adolescent boys and girls and weekly iron and folic acid supplementation to adolescent girls.

However, what was meant to be a cut and go scenario for the implementation project turned out to be a more complicated situation as girls were stopped from uptaking the supplementation. So as other schools kicked off with WIFS in January, St. Mary’s Asinge did not.  According to the then Acting Head Teacher Ms. Gloria Wekesa and the health teacher/WIFS Champion, resistance from a few parents led to resistance of all parents of girls who were targeted with the supplementation. “When a few parents initially refused their children from receiving the  IFA (iron folic acid) supplement, other parents heard of this and also barred for their girls from consuming the supplement, so no girl was receiving the supplements in the entire school,” they said.

Faced with this challenge from parents, the teachers knew that they had to change these perceptions if they were to see their girls taking the IFA supplement. Through funding from Nutrition International, teachers are empowered with knowledge so that they can articulate the benefits of the supplements to these parents. The teachers would also need to leverage their authority as opinion leaders in the community and good will to change the minds of the parents. The process begun with the teachers investigating the barriers to the uptake of WIFS and realized that the community around the school area is deeply rooted in cultural and religious beliefs which influenced the behavior and choices of most parents. It was found that the Asinge community is notorious for resisting and questioning any health program that is geared at improving the health of the population. The Asinge also remain skeptical of modern medicine hence do not consider seeking modern medical interventions when sick. Finally, they had a negative perception that WIFS was a camouflaged contraceptive or a fertility pill. For the teachers therefore, the problem was largely lack of knowledge and the solution was to close this gap with information on WIFS.“We realized that individually and collectively, we were responsible for bridging the gaps created by the lack of information on WIFS and had to rectify it immediately,” said Ms.  Wekesa.

The teachers got the local administration, that is, the Chief and Assistant Chief of Chakol Location, the Sub County Director of Education (SCDE) and the Diocesan Education Priest, Father Wesonga to intervene by being present and attesting that they are aware of project during the schools parents meeting.

A parents meeting was held to create awareness on WIFS and to address any concerns. At the meeting parents were sensitized on the project, why it was being implemented in the school, and the benefits the girls would reap from taking the supplement. This message was reconfirmed by the chief and assistant Chief, the Sub County Director of Education (SCDE) and the Diocesan Education Priest who confirmed that IFAS is a nutrition supplement which is similar to those given to pregnant women and is in line to the World Health Organization recommendations. Being a catholic school, the presence of Father Wesonga sensitizing them on the supplement and that it is in line with the Ministry of Education guidelines was appreciated by the parents who agreed to have their girls enrolled in the program.

When the WIFS programmatic team paid a visit to the school during part of routine supportive supervision, all (105) school girls between 10 – 19 years of age were taking the supplements. St. Mary Asinge has become a beacon of hope because the WIFS champions were able to arouse positive attitudes, driving the WIFS agenda from resistance to awareness to 100% practice.

 

 

FOCUS ON CHILD HEALTH

PS Kenya’s child survival efforts are focused on finding the most appropriate channels to reach caretakers and provide them with high quality, cost-effective and integrated health services that address the main causes of childhood disease and death. Our program addresses the common illnesses that children under 5 in Kenya encounter: diarrhea, pneumonia, malaria and malnutrition.

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THE NUTRITION PROGRAM

In Kenya, malnutrition is the single greatest contributor to child mortality, accounting for more than a half of deaths among children under five. In collaboration with the county governments, PS Kenya with support from UNICEF implemented a community-centered campaign to strengthen community resilience to handle shocks and stress in Kilifi, Kitui and Kwale Counties. The key practices were packaged in an umbrella campaign dubbed ‘Shika Tano’ (High 5) that supported and congratulated mothers who practiced 5 key behaviors. Shika Tano’s 5 key behaviors include:

  • Exclusive breastfeeding
  • Treatment of diarrhea with ORS and Zinc
  • Food diversity – giving foods from more than 4 food groups
  • Iron/Folate supplementation amongst pregnant women
  • Vitamin A supplementation amongst children 6-59 months

In Kitui County, PS Kenya is also supporting enhanced nutrition counselling among households receiving the cash transfer for improved nutrition outcomes. The program, known as NICHE (Nutrition Improvement Through cash and Health Education), is anchored on the Shika Tano campaign, with an additional emphasis on budgeting and meal planning and management.

STORIES OF CHANGE: THE OVERLOOKED CATALYSTS OF CHANGE

In PS Kenya’s implementation of the NICHE (Nutrition Improvement through Cash and Health Education) program in Machakos and Kitui, we visit households mapped to receive Orphans and Vulnerable Children Cash Transfer and in addition, the UNICEF cash top-up. In these select households, we carry out intensive nutrition counselling and health education targeting pregnant mothers and children less than two years of age with the aim of improving their nutrition and health status. The beneficiaries are counselled on Maternal,Infant, Young Child Nutrition (MIYCN) practices, their importance to health and how to adopt them by Community Health Volunteers (CHVs) trained to implement this program.

Our field activities bring us to the home of Wayua Munyoki in the remote arid lands of Kivaa ward, Masinga sub-county in Machakos. 40 year old Wayua is a mother of 8 children ranging between 25 years to 6 months and is a beneficiary of the UNICEF cash top up for her youngest child, baby Kanyipu. Because she has some mental challenges, Wayua is assisted to manage her family by a close relative.  We find Wayua outside her house breastfeeding baby Kanyipu. Around her, the younger children are playing about while the older ones are catching up with various house chores after returning from school. Upon our arrival, the children assemble and listen in to our discussion. The CHV, Joseph Munyoki informs us that this is usually the norm every other time he visits the household and finds the children home.

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As we continue our session, we notice that Leah, the fifth born child in standard three, is very engaged in the conversation. Every time we pose a question to her mother, she answers the question. Leah is aware about Shika Tano and how to tend to their kitchen garden which is providing a lot of important nourishment for the family. We were surprised to find out she knows and recalls some of the messages communicated and is aware of their importance to health, arguably better than the mother! We simply had to give her a high five! Together with her other siblings, the children help in carrying out simple activities that however impact highly on nutrition. They put up a hand washing facility (which at times their mother removes due to her mental condition) and ensure that it has water all the time.

As we left the household, we learnt something significant from Leah. Young children when present need not be left out during these learning sessions in the household visits. Like Leah, they can understand the messages being taught, take interest and in their small capacity, help their mothers/caregivers implement these behaviors like helping with simple tasks such as refilling the hand washing tin near the latrine, looking after their younger siblings or even merely reminding them; while adopting these practices themselves that are very beneficial to them and their entire families! Their engagement also means they grow into healthy, knowledgeable and productive youth and adults who become agents of change in sustaining an equally healthy, knowledgeable and productive society. Indeed, the NICHE program has many other change catalysts beyond caregivers!

Technology for Cervical Cancer Diagnosis

 

Cancer of the cervix is the fifth most common cancer among women worldwide. Cervical cancer is the second most common cancer after breast cancer at 19.3% and 20% of all reported cancers in Kenya, respectively (KEMRI, 2010). Cervical cancer is also the leading cause of death in women in Kenya.

Opportunities to prevent, cure and relieve suffering from cervical cancer exist through primary prevention of HPV infection, secondary prevention by screening, treatment of precancerous disease and early stages of cancer as well as tertiary care for women with invasive cancer.

In Kenya, it is estimated that only 3.2% of women aged 18-69 years have been screened in any 3-year period (WHO/ICO Information Centre on HPV and Cervical Cancer, 2010). Methods, such as DNA testing for human papillomavirus (HPV) and simple visual screening other than cytologic screening programs are more dependent on existing laboratory infrastructure may not serve the developing countries such as Kenya with constrained resources. Screening methods that can be incorporated into new strategies and would require fewer visits may prove more practical. Various tests have been recommended as screening methods in Kenya. They include Visual Inspection with Acetic Acid (VIA), Visual Inspection with Lugol’s iodine (VILI), Cytology using Conventional Pap smear and HPV testing. While VIA/VILI is widely used in developing countries, it has lower specificity (49-86%) compared to cytology.

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A study comparing accuracy of different screening methods shows that screening with VIA or VILI allows detecting presence of cervical cancer and its precursors with an accuracy as good or even better than the standard Pap smear test or testing for the presence of high-risk HPV with HC2 assay (Arbyn M, 2008). Efforts by PS Kenya to contribute to an increase of accurate and accessible screening services, equipped 75 of its social franchise Tunza Facilities to offer screening and Treatment of pre-cancer lesions by use of VIA/VILI to screen and cryotherapy machines to treat the positive lesions.

Some of the challenges with VIA/VILI is inability to preserve images for possible consultation (quality assurance support) and for evidence based feedback to clients (visualization of the process). Many clients get influenced and make informed decisions when they visualize and internalize their health concerns. PS Kenya’s Strategy involves targeting women aged 30-49 with information on Cervical Cancer screening and treatment of pre-cancer lesions through static and outreach models. Research has shown that targeting this specific age group for screening is more cost effective (Arbyn M, 2008). Besides equipping the provider with skills and logistics, PS Kenya reinforced and established referral mechanisms for bigger lesions or suspicious cases that require further management.

In July 2016, PS Kenya approached Mobile ODT, a company that developed the Eva (Enhanced Visual Assessment) System (a system that uses technology to diagnose cervical cancer), for a possible partnership. In September of the same year, PS Kenya and Mobile ODT agreed to conduct a pilot that would run for a period of 3 months in 2 Tunza facilities i.e. Wama Nursing home in Rongai and Boores Clinic in Thika. This pilot entailed the use of the Eva system in these facilities to assess the effect of better visualization of precancerous cervical lesions to both the provider and client.

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The Eva system is an image capturing device that used alongside VIA/VILI improves diagnosing of pre-cancerous lesions because visualization of the cervix is improved through magnification. The system provides the opportunity to capture images while performing cervical cancer screening using VIA/VILI and store in a cloud based data base for review at a later time. The captured images can therefore be shared for quality assurance support and mentorship so as to ensure clients are receiving the utmost level of care.The components of the Eva system that was used across the facilities are outlined below.

EVA SYSTEM

The Eva system is made up of 3 components i.e.

  1. Easy to use device: the Eva Scope is a mobile colposcope equipped with an ultra-bright light source and a powerful magnification lens for enhanced visualization.
  2. User friendly mobile App: the Eva App enables secure image capture and patient data tracking for remote consultation, patient tracking and improved referral and follow up.
  3. Cloud based information system: the Eva Cloud provides secure, everywhere access, to real time data to monitor provider utilization cases reviewed, anonymized patient statistics and intuitive tools to enhance quality control and quality improvement opportunities.

RESULTS

The pilot study showed an increased uptake of Cervical cancer screening as compared to an equivalent three month period. This is a 62 % and 16 % increase in Boore and Wama Nursing homes, this is a 58% average increase across the pilot sites.

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After the pilot period, results showed that the EVA system aids in better visualization of precancerous cervical lesions. Providers also felt that it supports objective support supervision and improves the confidence of both the provider and the client in the screening process a well as treatment uptake. This is evident for the increase in uptake of cervical cancer screening services.

Bibliography

Arbyn M, S. R. (2008). Arbyn M, Sankaranarayanan R, Muwonge R, Keita N, Dolo A, Mbalawa CG, et al., et al. Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India. International Journal of Cancer.
 

Sharing our Lessons in Malaria

THE MRDT PILOT PROJECT

PS Kenya has been implementing a pilot project in Coast Region that encourages the premise of testing every fever presented before treating. This WHO recommended guideline ensures that people presenting at a health facility with fever are not immediately given Malaria drugs because not all fevers are caused by Malaria. During the last quarter, PS Kenya disseminated their lessons from the pilot project in a meeting that brought together participants from WHO, DFID, the National Malaria Control Program, other NGO partners and private sector players.

According to WHO’s Officer in Charge and Malaria Advisor, Dr. Nathan Bakyaita, the findings of the mRDT(Malaria Rapid Diagnostic Tests) pilot project will be fed into a larger policy framework being developed by the World Health Organization. “The  mRDT project undertaken in 5 African countries, including Kenya by PS Kenya provides important insights that for Malaria Case Management in the private sector,” he added.

Since 2010, the Kenya government has required health workers to handle suspected Malaria cases according to the stipulated case management guidelines. While diagnostic implementation was being carried out at public health facilities, there was not much happening in the private sector before the intervention of the mRDT pilot project. “For us in government, projects like this one are important because ultimately it is in our interest that both public and private sector follow guidelines for suspected Malaria. We thank PS Kenya and its donors: UKAID and UNITAID, and even communities for taking part in this project,” remarked Dr. Waqo Ejersa, the Head at the Kenya National Malaria Program (NMCP).

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Reiterating the importance of intervening in the private sector was Dr. Dorothy Memusi who said that the private sector could no longer be ignored if the overall goal of ensuring that suspected malaria cases are tested before being treated. “When we began this pilot with PS Kenya, we were not sure whether it will work but since so many Kenyans access health services in the private sector, it has proven to be a success and an evidence to our push for universal testing and inclusivity of the private sector,” she said.

Indeed, implementing the project was not easy at the beginning since it involved introducing a new idea to private healthcare providers. For Malingi Mwasambu, the owner of Watamu Community Healthcare, a Tunza clinic; when the project started he was not very responsive to it. “A large number of clients that I tested for malaria with the RDT were negative and I live and work in a malaria endemic region. I concluded the tests did not work,” he said. It was after a meeting with other providers in the project held by PS Kenya that their fears were allayed and their confidence in the RDT grew. “I have to say that the training has helped and also the communications to the community about mRDT. Nowadays, my clients demand the test without me probing for it and the test is making me money,” he added.

The NMCP Head received an award from PS Kenya because of the overwhelming support the department gave during the roll-out of the project. PS Kenya’s Chief Operating Officer Joyce Wanderi-Maina added that although the project had come to a close, PS Kenya’s approach was to drive sustainability through a market facilitation process. “Normally for NGOs, our work involves short-term remedies to problems, just like putting out a fire. It however does not address the issue of underlying causes of the fire. With the mRDT project, we ensured that we address the underlying issues so that demand for mRDT in the private remains even after we are gone. We however hope that we can continue facilitating the market with more funding in future,” she added.

THE CONTINUOUS COMMUNITY NET DISTRIBUTION PROJECT

Malaria in Kenya remains a major public health problem with close to 70% of the population at risk (KMIS 2015). The revised Kenya Malaria Strategy 2009-2018 identifies malaria control interventions especially in scaling up distribution of LLINs through appropriate channels i.e. Mass net distribution every 3 years, routine distribution targeting pregnant mothers and children under 1 year through clinics, and social marketing. Following the mass net distribution of 2011/2012, about 67% households achieved universal coverage; however, sustaining high coverage and use levels is still a challenge. Other complimentary distributions mechanisms are therefore needed to reach the required target levels and sustain them over time.

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Through PMI funding and working with the NMCP, PS Kenya piloted a continuous community net distribution within Samia Sub-county, Busia County. Selection of Samia sub-county was based on the fact that it had functional community health units, beneficiary of the mass net distribution campaign of 2011/2012 and is malaria endemic with a prevalence of above 38% (KMIS 2010). Based on the Kenya Malaria Indicator survey 2015, malaria prevalence in this region has reduced to 27%.

The district was randomly divided into intervention and control sites (sub-locations). The objective of the study was to test the feasibility of sustaining universal coverage achieved during the mass net distribution through community based distribution mechanism. Implementation of the pilot involved a pull driven LLIN distribution mechanism where the need for an LLIN is determined at the household level using community health volunteers.  CHVs then verify the need by visiting the household and upon verification on need for a net, gives a coupon to HH head to redeem the LLIN at the nearest distribution point for free.

These trained CHVs integrated active interpersonal communication to encourage net use at both household level and at small group sessions (SGS). During the pilot period, a total of 28,928 out of the target 29,615 nets were distributed to the target audience within 18 intervention sub locations in Samia sub-county. CHVs saved 4,013 nets that were found viable i.e. still in usable condition or torn but repairable.

Utilizing a community cluster randomized controlled design, data was collected before (at baseline) and after (at follow-up) the roll out of the intervention. A household questionnaire was used to collect quantitative data while a structured qualitative questionnaire was used to assess the feasibility of using community based approaches to distribute the nets.

In August 2016, PS Kenya disseminated the results of this pilot to the Busia county stakeholders who included representatives of the National/County Government, NGO’s, Private sector and the community members. Dr Itur Asoka, who is the Chief of Health in the County, represented the County Minister for Health who was to be the chief guest in the meeting.

The end of project evaluation report showed that net use for the general household had increased from 80% at baseline to 93% at end line. In addition, 85% of respondents indicated confidence to hang a net at end line as compared to 73% at baseline. This is attributed to the interpersonal communication sessions facilitated by the CHVs. Qualitative data showed that the Samia community was very positive about the work of the CHVs.  “Going forward, we aim to use the lessons learnt in this pilot to inform future programs” said Dennis Mwambi, a senior manager at PS Kenya.

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 Another noticeable finding is the immense significance of community health workers who were pivotal in implementing this program, as they ensured that the community was well educated on the importance of using nets and as a result their efforts triggered many to embrace their use. “We have strong leadership and commitment from the county but the key to success was the community health volunteers who have been the cornerstone of the project,” said Dr Anne Musuva, MCH Director at PS Kenya. “We have never seen such a high net coverage level like the way we have seen in Samia, especially on this pilot project,” continued Dr Ann Musuva.

Participants at the meeting adopted the findings vowing to continue to play their part to ensure malaria is eliminated in the county.  “We as a County are very happy with these findings and going forward we promise to take it up to ensure that Malaria is completely neutralized in this County,” said the Busia County Chief of Health Dr Itur Asoka.